03070134 CITY OF CUPERTINO .tee _
BUILDING DIVISION PERMIT ICON kXICTQORRANFORMAATI ON:',
BUILDINGADDRUS: HIGHLAND CONSTRUCTION AND IND03070134
OWNE ' NAME: PERMIT ISSUE DATE
D 1ELL0 20073 NORTHCREST SQNIA .
6.
4082411858 SANITARY 140. CONTROL NO.
CHITECf/ENGINEER: VBUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
LOO LICENSED CONTRACTOR'S DECLARATION Job Description
11¢mhy affirm Nm 1 am Ilceeacd under provisions of Chapicr 9(commencing
with Section TIM)of Division 3 of the Businuaand®ufcssions Cook.and my license is
D7fu"ms;de t Lic.N .3S� fA�EVISION--ELECT CIRCUITS/BEAM CHANGE
C°"""° NO NEW PERMIT ISSUED, ORIG. 401050188
q"I ARCHITECTS DELL
2!] undcrxunJ my planvhall he used as public rccnrtlx
DyU
Licemcd Pmfcssisnel
3 Oat I A.GUILDER DECLARATION
Contractor's
E 2 y I hereby affirm that 1 am exompc from the Contractor's e:Any
4w for my
E20 p O following mann.(Section 9831.5,Businus and improve.
de nm Code:Any city s county t�
the
pooch nqua permit w mouton,aloe improve,h Pennitt or e a sig any atnnum v
F¢i
poor wi6 issuance.ensantlw to the provisions of
for sucChronicler's
pRmi's El=Law(cha moot
Ym p Chet he is licensed pursuant to pmvisinnsnRM Comnnoh Lime la on,C(chapter Sq. Ft. Floor Area 'on ho
e'F (commencing with Section 7000)of Division 3 of the Business and PmfnsinnbCMe)or 44
$ that he Is exempt therefrom and the buss for the alleged exemption.Any vinla0on of
Section 7031.5 by any applicaut for a permit subjects the applicant to a civil penally of dBAL , i00 Occupancy Type
not mart Nan Eve hundred della.(5300). 3
MN O rATw1 HAC
Lssnwnork.the property,or mycmptended with Bred raise[.(Sec.
0o 1,B sins,
will dothework,and the he Contractor's
noti Licensor offend Londe(Sec.to
owner
and arty he
Code;The improve.
License Law docs not apply to an owner of Required Inspections
property pita bulltlsorimproves thereon,and whodoeuuch work himself or through his 101 - FOUNDATION
own employees.provided that such improvements are net intended or offered for sale.If, 102 — PIERS
however,the building or improvement is sold within one year of completion.the owner
builder will have the burden of proving that he did not build or improve for purpose of 103 - UFER
Sale.).
❑L as owner of the property,am exclusively contracting with licensed contractors to 104 - REBAR
construct the project(Sec.7W,Business and Professions Cade:)The Contractor's Li. 105 — ANCHOR BOLTS.
come law does not apply to an owner of property who Wilds or improve thereon,and 10 6 - SEWER & WATER
who contracts for such projects with•cnntncwr(s)licensed pursuant to the Contractor's
Low..Law. 202 - UNDERFLOOR PLUMBING
❑Iamexempt under Sec.J / BkPCfo thin nn 203 - UNDERFLOOR MECHANICAL
wncr 2rV 7V 'S�/��lX//i Dale 7 O�
woERscoMATI 204 - UNDERFLOOR FRAME
I hereby affirm under penalty of perjury ore of the following declarations. 205 — UNDERFLOOR INSULATION
have and will maintain a CeniEcata of Consent to sal6insum for wminesChmpen- 301 — ROUGH PLUMBING
fp pnvichd for by Sector,37W of the Labor Code,for the perfmmana of the 302 - TUB & OR SHOWER
or which this permit is issued.
❑1 have and will maintain Wmtrr's Compcnminn Insunna,as required by Section 303 - ROUGH MECHANICAL
39IX1°ftheLxWr Codc.f°r they rf-moon" a nn for which this pmmit isissued. - 304 - ROUGH ELECTRICAL
We Ier'a 1 s ex an y rs°,,xraga��, 305 - FRAME
CERn[5' OFE%E PTIOoliNFRO WORFI KERS' 306 - HOEDOWNS
COMPENSATION INSURANCE 307 - INSULATION
(The;section need not he completed if the permit is for one hundred dollars(SIM) 308 - SHEETROCK
or less)
I sonify that in the performance or won for which this permit is ipued,1 shall not 309 — EXTERIOR LATH
employ any person in any manner anastobecome subject tothe worlac Compensation 310 - INTERIOR LATH
Laws of California.Date
Applicant 311 - SCRATCH COAT
NOTICE TO APPLICANT:IL shut making this Cenineste of Exemption,you ahouW 313 - ROOF NAIL
become subject to the Worker's Compensation previsions of the Lahm Code,you must
3z forthwith comply with such provisions orthis permit shall ledeemed nvoked. 501 - FINAL ELECTRICAL ENERGY
z0 CONSTRUCTION LENDING AGENCY 502 - FINAL PLUMBING ENERGY
'F�1 Ihereby afOrm Nn therei,.emost"ctinnlending agency for the performmccof 503 - FINAL MECHANICAL ENERGY
aim the work fur whichthis permit is issued(See3(199,Civ.C.)
W ^p Lenihh'sName 504 - FINAL BUILDING ENERGY
a Lender's Address
U Z 505 - FINAL ELECTRICAL
V O 1 certify that 1 ply read thio application and ren than the above information ix 506 - GAS TEST
W U building I q.e to comply with all city and county rmove;of and cute laws relating to
O V building conswnion,and hereby euthori>e rtpmsenutivu of this city to boor upon the FIN PLUMB G '
C abwve-mentioned pmpeny for inspection purposes.
(We)ague to save,indemnify and keep harmless the City o(Cuponino against Q 8 F I L
H y fabilitlu,judgmcnu.costs and caresses which may in anyway seems againblpid City 5
V z consequence of the granting of this permit.
PPLICAN 0 TANDS D 1 COMPLY WITH ALL ON-PO NT Issued by:5 ING 4Dats Rc cuL s. 514 NAL PUBLIC WORK
Re-roofs
Signature of Applicant/Comracwr R Da
HAZARDOUS MATERIALS DISCL Type of Roof
Will the applicant or future building occupant store or handle hazardous motorial
as defined by the Cupertino Municipal Code,Chapter 9.12,and the Health and Safety
Code,Section 255324)? All roofs shall be inspected prior to any roofing material being installed.
❑Yca u
Will the applicant or arum building occupant use equipment or devices which If a roof is installed without first obtaining an inspection,I agree to remove
i humidities air contaminants donned by the Bay Arca Air Quality Managcmom all new materials for inspection.
I' Yes Vu
I have mail the hmardous materials rcyuimments under Chapter6.95 of the Califor.
n1.1icalth&SafmyC,M:,Seco°m25505,25533and25534.1under undth I f sat, holding
Jces
no corwo, base a mneor,that h o my r nsfroo,w no the occupant of the
w cwhich ch nhemsecp' to u ccofeCcnifcauof c ancy. nature of Applicant Date
17
wncr ur awhonrcd egcm m All roof coverings to be Class "B"or better
6y5 ,
CITY OF CUPERTINO
CUPEINO PERMIT APPLICATION FORM 3 w13
I—VN # Date:
7/7lo3
Building Address:
/0076 AWe G dR•
Owner's Name: Phone#:. �/T.
S9G6 yZs
u /�tf} /ro �'O
Contractor: License #: 7S2 gs
2.
Contact: M / `/� Cupertino Business License#:
Bui rmit In o•
]dg
rA Elect Plumb ❑ Me
J es ption: (�
Residential Com�herc�
Sq.Ft. Floor Area: $/Sq.Ft.:
Cost of Project: Occupancy Group:
Type of Construction: l� r
Quantity Fee I Fee Description Fee Group
BAPPLOTHER Other Appliances MECHANICAL
BBLDGFEE Bldg Permits . foot BUILDING
BBOILERI Boiler<= 100,000 Btu MECHANICAL
BBOILER2 Boiler> 100K to 50OK Btu MECHANICAL
BBOILER3 Boiler> 500K to 1M Btu MECHANICAL
BBOILER4 Boiler> 1M to 1.75 M Btu MECHANICAL
BBOILER5 Boiler> 1.75M Btu MECHANICAL
BCONSTAX Construction Tax BUILDING
BCONSTAX Ind/Off/Comm/Quasi BUILDING
BCONSTAXBQ Con. Tax for BQ Zone BUILDING
BCONSTAXH Hotel and Motel BUILDING
BCONSTAXR Constax—Resi/Mobile BUILDING
BELEC1000 Elec 600V <= IOOOA ELECTRICAL
BELEC1001 Elec 600V> 1000A ELECTRICAL
BELEC200 Elec Svcs 600V <=200A ELECTRICAL
BENERGY Energy BUILDING
BENERGYADD Energy Add Multi BUILDING
BINVESTIGA Investigation fee BUILDING
BMITIGATC Comm. Housing Mit, Fee BUILDING
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Ai,'` CITY OF CUPERTINO
CIry° PERMIT APPLICATION FORM
Ah CUPEkTINO
Quantity Fee ID Fee Description Fee Group
BMITIGATR Res. Housing Mit Fee BUILDING
BMNEWMULTI New Multi-Family Res MECHANICAL
BMNEWSF&2F New Sf&2F Res Bldgs MECHANICAL
BNEWMULTI Multifamily Res ELECTRICAL
BNUCOMME New Comm Electric ELECTRICAL
BNUCOMMM New Comm Mechanical MECHANICAL
BNUCOMMP New Comm Plumb PLUMBING
BNUMULTI New Multifamily Res PLUMBING
BNUSFD New Single Family Res BUILDING
BOVERTHVIE Inspection Overtime BUILDING
BPBACKFLOW Atmospheric Vacuum PLUMBING
BPCESSPOOL Cesspool PLUMBING
BPERMFEE Bldg Permit Fees BUILDING
BPFIXTURE Pblg Fixture PLUMBING
BPGAS Gas Piping System Fee PLUMBING
BPINTERCEP Ind Waste Interceptor PLUMBING
BPLANCHK Plan Check Fee BUILDING
BPLANCKADD Plan Check Add Multi BUILDING
BPLANCKREP Plan Check Repeat Fee BUILDING
BPREPIPE Re i eOfFixtures PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BPSEWER Sewers PLUMBING
BPSPRINK Lawn S rinklerBackflo PLUMBING
BPSTORM Storm/Rain Water PLUMBING -.
BPTRAP Kitchen Trap PLUMBING
BPVENT Alt of Drain &Vent PLUMBING
BPWATER Install/Alter Water Pie PLUMBING
BPWHEATER Water Heater/Vent PLUMBING
BPWSVCS Main Water Service PLUMBING
BREINSPECT Reinspection Fee BUILDING
BREMACOVER A/C Unit> 10,000 cfm MECHANICAL
BREMAIRHAN A/C Units<= 10,000 cfm MECHANICAL
BREMAPPLI Appliance Install MECHANICAL
BREMBUSWAY Remodel Busways ELECTRICAL
BREMFD{T Lighting Fixtures ELECTRICAL
BREMFURN Relocation of Furnace MECHANICAL
BREMFURNOV Relo Furnace> l OK btu MECHANICAL
BREMHEAT Heater Installation MECHANICAL
BREMINHOOD Installation of Hood MECHANICAL
BREMMISC Misc Apparatus ELECTRICAL
BREMNRAPP Rem Non-Res Appliance ELECTRICAL
BREMPOLE Pole/Platform Fixture ELECTRICAL
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t .
CITY OF CUPERTINO
cuP TYOF PERMIT APPLICATION FORM
QuantityFee ID Fee Description Fee Grou
BREMPOWER Power Device/Apparatus ELECTRICAL
BREMRECEPT Rc tl, Switch& Outlets ELECTRICAL
BREMRELOCA Relocation of Hood MECHANICAL
BREMREPALT Repair/Alter Heating MECHANICAL
BREMRESAPP Remodel Res Appliance ELECTRICAL
BREMSIGNAD Rmdl Signs Add Branch ELECTRICAL
BREMSIGNS Remodel Signs,Marquee ELECTRICAL
BREMTHEATR Theatrical Lighting Fix ELECTRICAL
BREMVENFAN Vent Fan Single Duct MECHANICAL
BREMVENSYS Ventilation Systems MECHANICAL
BSCBLVD Scb Specific Plan BUILDING
BSEISMICOM Seismic Commercial BUILDING
BSEISMICRE Seismic Fee Res BUILDING
BSPECLU Special Insection BUILDING
BSWIM Swimming Pool BUILDING
BTEMP Temporary Power ELECTRICAL
BTEMPPERM Temporary Bldg Pemiit BUILDING
BTEMPSVCS Temp Dist Svcs ELECTRICAL
BUSLIC Business License BUILDING
ELECTRIC Electrical sq foot ELECTRICAL
EPERMITFEE Elec Permit Issuance ELECTRICAL
MPERMFEE Mechanicals . foot MECHANICAL
MPERMITFEE Mech Permit Issuance MECHANICAL
PPERMITFEE Plumbing Permit Issuance PLUMBING
PPLBG Plumbing Fee sq foot PLUMBING
ZADDCHG Address Chane BUILDING
y
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